There are options to help you cope. Call the toll-free, hour hotline of the National Suicide Prevention Lifeline at TALK to be connected to a trained counselor at a suicide crisis center nearest you. The National Center on Substance Abuse and Child Welfare offers free technical assistance to a various of systems on making policy and practice changes to improve outcomes for families affected by substance use disorders and involvement with child welfare services.
Screening and Assessment When a family comes to the attention of child welfare services, determining the presence of a parental substance use and mental disorders, as well as related child and family effects, is the first step in ensuring the safety, permanency, and well-being of the family.
National Center on Substance Abuse and Child Welfare, This webinar provides information on screening and assessment for family engagement and retention as well as strategies and issues related to both the systems and practice level. PDF KB. National Center on Substance Abuse and Child Welfare, Child welfare professionals can use this technical assistance tool to access information about identifying and addressing substance use disorders by parents involved with child welfare services, including signs and symptoms, screening practices, and referral for assessment.
Screening and Assessment Tools Chart. National Institute on Drug Abuse, This chart is a comprehensive listing of substance use disorder screening and assessment tools that service providers can use with clients from adolescence to adulthood. PDF 4. Substance Abuse and Mental Health Services Administration, This publication provides child welfare policymakers with information about developing practice and policy protocols on the use of drug testing in child welfare practice.
PDF 3 MB. National Center on Substance Abuse and Child Welfare, This webinar provides an overview of collaborative practice at the front end of child welfare cases that involve families affected by substance use disorders e. Family Drug Court Training and Technical Assistance Program-Learning Academy, This webinar provides key elements of screening, assessment, monitoring, and the principles that drive these critical processes, as well as the importance of early identification, timely assessments, and ongoing monitoring.
Family Drug Court Training and Technical Assistance Program-Learning Academy, This webinar offers practice principles to guide screening and assessment protocols for working with families affected by substance use disorders and involvement with the child welfare system. Statewide System Reform Project Collaborative, This guide provides a discussion about universal substance use screening in child welfare and the five principles implemented by the demonstration sites from the Colorado Dependency and Neglect System Reform.
PDF 5. PDF Guidelines for Identifying Substance-Exposed Newborns. Arizona Statewide Task Force on Preventing Prenatal Exposure to Alcohol and Other Drugs, Created to address the growing epidemic of prenatal exposure to alcohol and other drugs, these guidelines provide best-practice resources for combatting the problem. Virginia Department of Social Services, Virginia law requires that as a routine component of prenatal care, mandated licensed practitioners establish and implement a medical history protocol that will screen all pregnant patients for substance use to determine the need for further evaluation.
Acculturation levels can affect screening and assessment results. Also be aware that even individuals who speak English well might have trouble understanding the subtleties of questions on standard screening and assessment tools.
Several common myths contribute to underassessment of trauma-related disorders Najavits, :. A trauma-informed assessor looks for psychological symptoms that are associated with trauma or simply occur alongside it. Symptom screening involves questions about past or present mental disorder symptoms that may indicate the need for a full mental health assessment. A variety of screening tools are available, including symptom checklists.
Responses will likely change from one administration of the checklist to the next. Basic mental health screening tools are available. A common dilemma in the assessment of trauma-related disorders is that certain trauma symptoms are also symptoms of other disorders. These symptoms need to be distinguished so that other presenting subclinical features or disorders do not go unidentified and untreated. Many trauma survivors are either misdiagnosed i.
Such diagnostic errors could result, in part, from the fact that many general instruments to evaluate mental disorders are not sufficiently sensitive to identify posttraumatic symptoms and can misclassify them as other disorders, including personality disorders or psychoses. Intrusive posttraumatic symptoms, for example, can show up on general measures as indicative of hallucinations or obsessions.
Dissociative symptoms can be interpreted as indicative of schizophrenia. Trauma-based cognitive symptoms can be scored as evidence for paranoia or other delusional processes Briere, Some of the most common misdiagnoses in clients with PTSD and substance abuse are:.
It is possible, however, for clients to legitimately have any of these disorders in addition to trauma-related disorders. Given the overlap of posttraumatic symptoms with those of other disorders, a wide variety of diagnoses often needs to be considered to avoid misidentifying other disorders as PTSD and vice versa. A trained and experienced mental health professional will be required to weigh differential diagnoses.
Behavioral health service providers must approach screening and assessment processes with the influences of culture, ethnicity, and race firmly in mind. Cultural factors, such as norms for expressing psychological distress, defining trauma, and seeking help in dealing with trauma, can affect:.
When selecting assessment instruments, counselors and administrators need to choose, whenever possible, instruments that are culturally appropriate for the client. Instruments that have been normed for, adapted to, and tested on specific cultural and linguistic groups should be used. Instruments that are not normed for the population are likely to contain cultural biases and produce misleading results.
Subsequently, this can lead to misdiagnosis, overdiagnosis, inappropriate treatment plans, and ineffective interventions. Thus, it is important to interpret all test results cautiously and to discuss the limitations of instruments with clients from diverse ethnic populations and cultures.
Culture-specific symptoms and syndromes can involve physical complaints, broad emotional reactions, or specific cognitive features. Many such syndromes are unique to a specific culture but can broaden to cultures that have similar beliefs or characteristics.
Culture-bound syndromes are typically treated by traditional medicine and are known throughout the culture. Cultural concepts of distress include:. Sources: APA, , pp. Numerous instruments screen for trauma history, indicate symptoms, assess trauma-related and other mental disorders, and identify related clinical phenomena, such as dissociation. One instrument is unlikely to meet all screening or assessment needs or to determine the existence and full extent of trauma symptoms and traumatic experiences.
The following sections present general considerations in selecting standardized instruments. Define your assessment needs. Do you need a standardized screening or assessment instrument for clinical purposes? Do you need information on a specific aspect of trauma, such as history, PTSD, or dissociation? Do you wish to make a formal diagnosis, such as PTSD? Do you need to determine quickly whether a client has experienced a trauma? Do you want an assessment that requires a clinician to administer it, or can the client complete the instrument himself or herself?
Does the instrument match the current and specific diagnostic criteria established in the DSM-5? Consider the population to be assessed e. Is the assessment process developmentally and culturally appropriate for your client?
Exhibit 1. Key Areas of Trauma Screening and Assessment. Key question: Did the client experience a trauma? An instrument should be psychometrically adequate in terms of sensitivity and specificity or reliability and validity as measured in several ways under varying conditions. The recent publication of the DSM-5 APA, a reflects changes to certain diagnostic criteria, which will affect screening tools and criteria for trauma-related disorders. There are now four cluster symptoms, not three: reexperiencing, avoidance, arousal, and persistent negative alterations in cognitions and mood.
Changes to the DSM-5 were made to symptoms within each cluster. Thus, screening will need modification to adjust to this change APA, b. Is the instrument freely and readily available, or is there a fee? Is costly and extensive training required to administer it?
Is the instrument too lengthy to be used in the clinical setting? How will results be presented to or used with the client? Is technical support available for difficulties in administration, scoring, or interpretation of results?
Is special equipment required such as a microphone, a video camera, or a touch-screen computer with audio? The following sections focus on initial screening. For more information on screening and assessment tools, including structured interviews, see Exhibit 1. Screening is only as good as the actions taken afterward to address a positive screen when clients acknowledge that they experience symptoms or have encountered events highlighted within the screening.
Once a screening is complete and a positive screen is acquired, the client then needs referral for a more indepth assessment to ensure development of an appropriate treatment plan that matches his or her presenting problems.
A person cannot have ASD, PTSD, or any trauma-related symptoms without experiencing trauma; therefore, it is necessary to inquire about painful, difficult, or overwhelming past experiences. Initial information should be gathered in a way that is minimally intrusive yet clear. Brief questionnaires can be less threatening to a client than face-to-face interviews, but interviews should be an integral part of any screening and assessment process. If the client initially denies a history of trauma or minimizes it , administer the questionnaire later or delay additional trauma-related questions until the client has perhaps developed more trust in the treatment setting and feels safer with the thoughts and emotions that might arise in discussing his or her trauma experiences.
Using the SLE can foster the client—counselor relationship. By going over the answers with the client, you can gain a deep understanding of your client, and the client receives a demonstration of your sensitivity and concern for what the client has experienced.
SLE Screening. Please fill in the number that best represents how much the following statements describe your experiences. You will need to use two scales, one for how well the statement describes your experiences and one for how stressful you found this more In addition to broad screening tools that capture various traumatic experiences and symptoms, other screening tools, such as the Combat Exposure Scale Keane et al.
Have you ever been in a relationship where your partner has pushed or Slapped you? Have you ever been in a relationship where your partner Threatened you with violence? Have you ever been diagnosed or treated for a psychological disorder in the past? Have you ever been prescribed medications for your emotions in the past? See Appendix D for information on specific instruments. Current research Prins et al. If sensitivity is of greater concern than efficiency, a cutoff score of 2 is recommended.
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month , you… Have had nightmares about it or thought about it when you did not want to?
Another instrument that can screen for traumatic stress symptoms is the four-item self-report SPAN, summarized in Exhibit 1. SPAN is an acronym for the four items the screening addresses: startle, physiological arousal, anger, and numbness. The SPAN. The SPAN instrument is a brief screening tool that asks clients to identify the trauma in their past that is most disturbing to them currently.
It then poses four questions that ask clients to rate the frequency and severity with which they more The SPAN has a high diagnostic accuracy of 0. When using the checklist, identify a specific trauma first and then have the client answer questions in relation to that one specific trauma.
Instructions to Client: Below is a list of problems and complaints that people sometimes have in response to stressful experiences. Please read each one carefully and circle the number that indicates how much you have been bothered more Along with identifying the presence of trauma-related symptoms that warrant assessment to determine the severity of symptoms as well as whether or not the individual possesses subclinical symptoms or has met criteria for a trauma-related disorder, clients should receive other screenings for symptoms associated with trauma e.
It is important that screenings address both external and internal resources e. Behavioral screening is often folded into the developmental screening tool, but sometimes it isn't. Screening is a great way for us to ensure that we have good baseline data. It helps parents engage in the process and support their children in getting services that they may need. After the screening, if no concerns are identified, the child is then assessed.
Assessment is an ongoing examination of a child's development over time, to make sure the child is progressing and meeting milestones. As an ECE professional, assessment is something that you do throughout your daily life to ensure that the children in your program are receiving the kinds of educational opportunities that help them progress.
Assessment provides information for planning and individualization. It occurs at the same time as health providers conduct developmental monitoring. Assessment may identify developmental concerns not identified in screening, which would then warrant an evaluation. An evaluation is conducted to determine whether a child is eligible for services through the Individuals with Disabilities Education Act. The child would be evaluated to determine whether he would get an individual family service plan IFSP or an individualized education plan IEP.
There are times when the screening identifies a child who has some red flags but is not to the degree that you would want to refer. We'll talk a little more about how to make those decisions coming up later in the presentation.
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